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By: William A. Weiss, MD, PhD

  • Professor, Neurology UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA

It could then be held that the former had survived the latter with far-reaching medico-legal implications regarding the disposal of estates discount 500mg valproate mastercard. An assessment of the nature and cause of injuries is required so that consideration can be given to cheap valproate 500mg with mastercard appraising safety features within the aircraft and to purchase 500 mg valproate overnight delivery improving them cheap 500 mg valproate fast delivery. Examples include penetrating head injuries or crushing fractures of the lower legs. Similarly, in the presence of extensive cranial injury it would be only a careful examination that would reveal a cerebral arterial aneurysm. When correlation of all this evidence has been effected by the Investigator-in-Charge, through the reports of the Human Factors Group and other groups, it will be possible to put forward any theory formed concerning human factors on the flight deck in relation to the circumstances and the cause of the accident with a balanced judgement as to its probability. Nevertheless, there are certain points that should not be overlooked in the examination of any body. Much additional information may be derived by comparing the pattern of injuries in the passengers with the pattern in the cabin crew. This could suggest some unusual incident and the interpretation of the findings depends to a large extent on accurate identification and location in the aircraft according to the passenger seating plan. It may be the only means by which a case of sabotage or unlawful interference with the operation of the aircraft is revealed. Anomalous findings may give a clue to such accident causes as failure of the automatic pilot or attempted interference with the normal operation of the aircraft. Injuries discovered should be, whenever possible, related to specific items of equipment in the cockpit. To this end a search should be made for the presence of blood and other tissues on the seats, instruments and control columns. Of greater importance, the overall tightness of belts should enable the investigator to distinguish between a cabin that has been prepared for an emergency landing and one in which the passengers have been sitting with their belts lightly fastened as a routine. Particular attention should be given to any condition likely to have led to incapacitation in flight or to a deterioration in fitness and performance. Visual and auditory acuity of the crew should also be noted but, again, it will be the essentially negative pathological findings in an accident suspected of having a human factor cause that will focus attention on these systems. However, well-documented abnormalities of this sort are scarcely compatible with modern flight crew selection methods or effective working as part of an airline operation. It may be that information obtained from friends, relatives, acquaintances, supervisors, instructors, personal physicians and other observers as to both the recent activities and attitudes of the flight crew and to their long-term personal and flying habits, general health and ordinary behaviour may provide information which is of far greater value. Human elements of perception, judgement, decision, morale, motivation, ageing, fatigue and incapacitation are often relatively intangible, yet highly pertinent variables. It should be emphasized that a positive association between any such abnormality discovered and the cause of the accident can seldom, if ever, be better than conjecture. It may be necessary to include a psychologist familiar with aviation in the Human Factors Group. For example, a deviation from the flight path might suggest a need for an examination for carbon monoxide intoxication; a suspect pressurization system might indicate a need to confirm or exclude hypoxia as a cause of the accident. These are the sort of matters that emphasize the need for frequent meetings of the heads of the investigation groups and the need for adequate exchange of information at such meetings. These may be related to auditory, visual, tactile or postural stimuli; b) errors of judgement and interpretation. Misjudgement of distances, misinterpretation of instruments, confusion of instructions, sensory illusions, disorientation, lapse of memory, etc. It is in the evaluation of these potential factors that the Human Factors Group may be of invaluable assistance to the Investigator-in-Charge. For example, it may be suggested that the pilot was particularly irritable at the time of the flight. However, a replay of the recordings of his in-flight transmissions may give far better evidence as to whether this effect was operative at the time of the accident. Before taking such specimens, however, the investigator should ensure that there are no local legal contraindications. The findings must be collated with their seat position, or location in the aircraft, and adjacent environment so that preventive action such as redesign may be considered. Adequate, regular debriefing sessions may help prevent the occurrence of Post Traumatic Stress Disorder. The Investigator-in-Charge must ensure that important investigative information is not sacrificed to meet social and legal desires for rapid identification and disposal of bodies. To this end, he should, if possible, obtain the services of a pathologist familiar with aircraft accident investigation who is capable of coordinating the two interdependent functions of investigation and identification. Coincidentally with this investigation, evidence of medico-legal significance as to identification will automatically emerge, particularly if each examination is enhanced by the coordinated efforts of the pathologists, police, odontologists, radiologists, etc. For their part, the head of the Human Factors Group and the Investigator-in-Charge must ensure that the pathological findings are taken as but part of the investigation as a whole and are fully correlated with evidence adduced within the Group and by other Groups. Experience has shown that this is facilitated and maximum advantage gained if the pathologist attends the periodic briefings by the Investigator-in-Charge. Reals (eds), Aerospace Pathology, College of American Pathologists Foundation, Chicago, Illinois, 1973. Some of the reasons for a national reference laboratory include the following: a) to ensure standard results across the country, with a high level of expertise; b) to provide rapid response to investigators; c) to offer special tests not performed by other forensic laboratories, but which are required by air accident investigators; d) to work at levels of sensitivity which would pick up sub-therapeutic and trace concentrations of analysed compounds; e) to provide forensic analyses on tissue samples in cases where fluids are unavailable; f) to assist in the interpretation of results with respect to a causal, contributory or incidental role in accident occurrence or impact on survivability; g) to undertake special studies as may be required to determine human factor input to the accident; h) to keep a computerized data archive of relevant toxicological, biochemical and pathological findings to detect disease prevalence, drug use or toxin exposure from a national perspective. More demanding tests require more time, but a complete report should be issued after two to five weeks. Forensic odontologists synthesize principles, knowledge and competence from many aspects of dentistry with those of other disciplines, as for example forensic pathology/medicine, genetics, anthropology and criminology. A forensic odontologist with extensive experience in identification work involving foreign nationals should be appointed to the identification commission (the aviation pathology team) responsible for the organization and legal aspects of the identification process. On the site, the main task of the forensic odontologist is to give a preliminary description of the face and dentition of recovered bodies and otherwise help in the search for bodies or body fragments and assist whenever required. Forensic odontologists, with or without assistance from other professionals (police, forensic pathologists, etc.

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However cheap 500mg valproate free shipping, a transvaginal ultrasound is performed using a probe that is in serted into the vaginal canal effective valproate 500 mg. It may also be used to buy valproate 500mg cheap get a clearer view of the uterus or ovaries if a problem is suspected 500 mg valproate with mastercard. Be sure to tell the ultrasound doctor whether or not you want to know the gender of your baby. There is a chance that 25 the ultrasound images can be During the test misinterpreted. An ultrasound You will lie on a padded examining might be performed earlier in your table during the test. A small device, called a transducer, Later in pregnancy, ultrasound is gently applied against the skin on might be used to determine: your abdomen. The transducer • Fetal well-being sends high-frequency sound waves • Placenta location into the body, which refiect off • Amount of amniotic fiuid around internal structures, including your the baby baby. Even though ultrasound There is virtually no discomfort is safe for mother and baby, it is a during the test. If a full bladder is test that should be done only when required for the test, you might feel medically necessary. If you have an some discomfort when the probe is ultrasound that is not medically nec applied. You might be asked to hold essary (for example, to simply see the your breath briefiy several times. This will help interpreted by a board-certified the doctor view the baby better on physician. You will be allowed to go to the bathroom right after the test has ©Copyright 1995-2015 the Cleveland Clinic Foundation. Every woman’s pregnancy is unique, and some of these discomforts might not affect you. Round • Apply a hot water bottle or heating pad, or take a ligament pain is consid warm bath or shower. Irregular, Regular tightening or pain in your back or infrequent contrac lower abdomen tions are called Pressure in the pelvis or vagina Braxton Hicks Menstrual-like cramps contractions. Bleeding Fluid leakage Flu-like symptoms such as nausea, vomiting, and diarrhea Backaches • Wear low-heeled (but not flat) shoes. The increase in your • Get a dental checkup early in your pregnancy to make sure volume of circulation your teeth and mouth are healthy. Your crease in size as your milk glands enlarge bra should fit well without irritating your nipples. Close your occur and how bad they eyes and try to release the tension in your back, neck, are can vary. Or, place pillows under your shoulders to prevent to changing hormone stomach acids from rising into your chest. Leg cramps • Be sure to eat and drink foods and beverages rich in cal cium (such as milk, broccoli, and cheese). Nasal congestion • Apply a warm, wet washcloth to your cheeks, eyes, and nose to reduce congestion. Nausea is a result • Contact your health care provider if your vomiting is constant of hormonal or so severe that you can’t keep fluids or foods down. You might feel short • Avoid lying flat on your back, and try sleeping with your head of breath when walk elevated. Stretch marks are a • Apply lotion to your skin to keep it soft and reduce type of scar tissue dryness. Stretch marks affect the sur face under the skin and are usually not preventable. Swelling in the • Drink plenty of fluids (at least 10 to 12 glasses of fluids a day). Tight clothing can slow blood vessels carrying blood from the lower circulation and increase fluid retention. This might be a warning sign of preeclampsia or toxemia, a pregnancy related high blood pressure. Varicose veins Although varicose veins are usually hereditary, here are some preventive tips: An increased volume • Avoid standing or sitting in one place for long periods. All rights reserved Index# 5186 34 Vaccination During Pregnancy Why is vaccination necessaryfi Vaccines strengthen people’s immune systems so their bodies can fight off serious infectious diseases. Some people might be allergic to an ingredient in a vaccine, such as eggs in the infiuenza vaccine, and should not receive the vaccine until they have talked to their doctors. The following vaccines are consid the following vaccines can ered safe to give to women who potentially be transmitted to the might be at risk of infection: unborn child and might result in miscarriage, premature birth, or Hepatitis B — Pregnant women who birth defects: are at high risk for this disease and have tested negative for the virus can Hepatitis A —The safety of this vac receive this vaccine. You can receive Women should wait at least one the vaccine at any stage of your preg month to become pregnant after re nancy. Tetanus/Diphtheria (Tdap) — Tdap Varicella —This vaccine, used to pre should be administered during vent chicken pox, should be given at pregnancy, preferably during the least one month before pregnancy. If you are non-immune and are ex posed to active chicken pox, you need to call your doctor’s office for direction. You can also get it from eating undercooked meat from animals infected with the parasite or from uncooked foods that have come in contact with contaminated meat. If you have been infected with Toxoplasma once, you usually will not become infected again.

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It has been firmly established that hyper death from myocardial infarction is related to quality 500mg valproate underlying cholesterolaemia has directly proportionate relationship with atherosclerosis discount 500mg valproate amex. It is estimated that cholesterol esters buy generic valproate 500 mg line, largely derived from the lipoproteins in by the year 2020 best 500mg valproate, cardiovascular disease, mainly the blood. Often, they are acting in combination rather causes such as in diabetes mellitus, myxoedema, nephrotic than singly. These risk factors are divided into two groups syndrome, von Gierke’s disease, xanthomatosis and familial (Table 15. Diabetes mellitus ciency, oral contraceptives the concentrations of different lipoproteins in the serum. Physical inactivity lipoproteins are divided into classes according to the density B) Constitutional 5. Chylomicrons Liver, intestine, macrophage — Indirect different apoproteins being named by letter A, B, C, D etc down, while the other good plasma lipoprotein. Hypertension is a risk factor for all 140-200 mg/dl, while levels of borderline high are considered clinical manifestations of atherosclerosis. An elevation of total serum doubles the risk of all forms of cardiovascular disease. It acts cholesterol levels above 260 mg/dl in men and women probably by mechanical injury to the arterial wall due to between 30 and 50 years of age has three times higher risk of increased blood pressure. The extent and severity of atherosclerosis cholesterol and has the maximum association with athero are much greater in smokers than in non-smokers. Clinical manifestations of produced by artificial hydrogenation of polyunsaturated fats) atherosclerosis are far more common and develop at an early which raise the plasma cholesterol level. On the contrary, characterised by metabolic (insulin resistance) syndrome and a diet low in saturated fats and high in poly-unsaturated fats abnormal lipid profile termed ‘diabetic dyslipidaemia’ is and having omega-3 fatty acids. Age, sex and genetic influences do affect the appearance of Currently, management of dyslipidaemia is directed at lesions of atherosclerosis. Thus presently, preferred term for early lesions of atherosclerosis may be present in childhood, hyperlipidaemia is dyslipidaemia because one risky plasma clinically significant lesions are found with increasing age. The incidence and severity of atherosclerosis are more in men than in women and the changes appear a decade Pathogenesis earlier in men (>45 years) than in women (>55 years). The concept hypothesised by oestrogen and high-density lipoproteins, both of which have Virchow in 1856 that atherosclerosis is a form of cellular anti-atherogenic influence. Genetic factors play a significant imbibing of lipids from the blood came to be called the ‘lipid role in atherogenesis. Modified form of this theory is currently known as lipoprotein metabolism predispose the individual to high ‘response to injury hypothesis’ and is now-a-days the most blood lipid level and familial hypercholesterolaemia. Racial differences too exist; Blacks have generally leucocytes, was named as ‘encrustation theory’ or ‘thrombogenic less severe atherosclerosis than Whites. Higher incidence of atherosclerosis in developed Though, there is no consensus regarding the origin and countries and low prevalence in underdeveloped countries, progression of lesion of atherosclerosis, the role of four key suggesting the role of environmental influences. Obesity, if the person is overweight by 20% or more, is the areas of disagreement exist in the mechanism and associated with increased risk. Physical inactivity and lack of exercise are associated with modified in 1986 and 1993 by Ross. Stressful life style, termed as ‘type A’ behaviour pattern, smooth muscle cells, postulated by Benditt and Benditt in characterised by aggressiveness, competitive drive, 1973. Patients with homocystinuria, an uncommon inborn error historical theories of atherosclerosis—the lipid theory of of metabolism, have been reported to have early Virchow and thrombogenic (encrustation) theory of atherosclerosis and coronay artery disease. Prothrombotic factors and elevated fibrinogen levels favour muscle cell proliferation so that the early lesions, according formation of thrombi which is the gravest complication of to this theory, consist of smooth muscle cells mainly. Role of infections, particularly of Chlamydia pneumoniae and sequently in 1993 implicates lipoprotein entry into the viruses such as herpesvirus and cytomegalovirus, has been intima as the initial event followed by lipid accumulation in found in coronary atherosclerotic lesions by causing the macrophages (foam cells now) which according to inflammation. Possibly, infections may be acting in modified theory, are believed to be the dominant cells in early combination with some other factors. The role of haemodynamic forces in causing endothelial injury is further supported by the distribution of atheromatous plaques at points of bifurcation or branching of blood vessels which are under greatest shear stress. Endothelial injury causes adherence, aggregation and platelet release reaction at the site of exposed subendothelial connective tissue and infiltration by inflammatory cells. Smooth muscle cell proliferation is also facilitated by biomolecules such as nitric oxide and endothelin released from endothelial cells. Intimal proliferation of smooth muscle cells is accompanied by synthesis of matrix proteins—collagen, elastic fibre proteins and proteoglycans. B, Adhesion of platelets and migration of blood monocytes by scavenger receptor on the monocyte to transform it to a from blood stream. Both these theories—original and modified, have attra cted support and criticism. As stated already, chronic generally accepted role of key components involved in dyslipidaemia in itself may initiate endothelial injury and atherogenesis, diagrammatically illustrated in Fig. As apparent from the foregoing, endothelial dysfunction may initiate the sequence of events. Numerous injury exposes subendothelial connective tissue resulting in causes ascribed to endothelial injury in experimental animals formation of small platelet aggregates at the site and causing are: mechanical trauma, haemodynamic forces, immuno proliferation of smooth muscle cells. This causes mild logical and chemical mechanisms, metabolic agent as chronic inflammatory reaction which together with foam cells is dyslipidaemia, homocystine, circulating toxins from systemic incorporated into the atheromatous plaque. The lesions infections, viruses, hypoxia, radiation, carbon monoxide and enlarge by attaching fibrin and cells from the blood so that tobacco products. This hypothesis is based on the postulate that proliferation of smooth muscle cells is the primary event and that this proliferation is monoclonal in origin similar to cellular proliferation in neoplasms. The monoclonal proliferation of smooth muscle cells in atherosclerosis may be initiated by mutation caused by exogenous chemicals.

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Arthropods affect the health of humans by being either direct agents for disease or agents for disease transmission 500 mg valproate visa. The arthropods of medical importance are found in Classes Insecta discount 500mg valproate with visa, Arachnida order valproate 500mg with amex, and Crustacia which have their own distinguishing features cheap valproate 500mg overnight delivery. In Class insecta the body is divided into head, thorax, and abdomen, with one pair of antennae. Diseases like malaria, yellow fever, onchocerciasis, and trypanasomiasis are primarily transmitted by insects. There is usually some association such as mutualism, commensalisms, or parasitism between the parasite and the host. This association may produce a variety of effects and the host usually tends to react to it. Understanding the various structural and behavioral components of parasites assists classification. In general, the protozoa, helminthes and arthropods are the most commonly studied and the most important parasites in medical parasitology. Give examples of reactions that occur in the body of the host following parasitic invasion. They may be distinguished from other eukaryotic protists by their ability to move at some stage of their life cycle and by their lack of cell wall. Colonies of protozoa might also occur in which individual cells are joined by cytoplasmic threads and form aggregates of independent cells. However, distinct types of protozoa, include a resistant cyst (non-motile) stage to survive adverse environmental conditions, such as desiccation, low nutrient supply, and even anaerobiosis. For example, the soil amoeba, Naegleria is a resistant cyst in dry 17 weather, a naked amoeba in moist soil, and becomes flagellated when flooded with water. Morphology of protozoa Protozoa are predominantly microscopic, ranging in size from 2 to more than 100fim. Morphologically, they are within a mass of protoplasm, consisting of a true membrane – bound nucleus and cytoplasm. The nucleus contains clumped or dispersed chromatin and central nucleolus or karyosome, which are useful structures to distinguish protozoan species from one another based on the shape, size and distribution of these structures. Importance of protozoa Protozoa serve as an important link in the food chain and ecological balance of many communities in wetland & aquatic environments. They are also important in biological sewage treatment, which involves both anaerobic digestion and/or aeration. In addition, protozoa are important laboratory organisms in research areas, by which their asexual reproduction enables clones to be established with the same genetic make-up. These are useful in the study of cell cycles and nucleic acid biosynthesis during cell division. Medical concern of protozoa Protozoa are ubiquitous in moist areas, including the human alimentary canal. From an ecological standpoint, protozoa may be divided into free-living forms and symbiotic forms. Although most amoebas are free-living, several are found as commensal inhabitants of the intestinal tract in humans. One of these organisms Entamoeba histolytica may invade tissue and produce disease. Flagellates of the genus Trypanosomes and Leishmania are capable of invading the blood & tissue of humans, where they produce severe chronic illness. Others such as Trichomonas vaginalis and Giardia lamblia, inhabit the 18 urogenital and gastrointestinal tracts and initiate disease characterized by mild to moderate morbidity but no mortality. Sporozoan organisms, in contrast, produce two of the most potentially lethal diseases of humankind: malaria and toxoplasmosis. Most of the parasitic incidents belong to endocellular protozoa of different genera or species. Reproduction and regeneration of protozoa As a general rule, protozoa multiply by asexual reproduction. Some parasitic forms may have an asexual phase in one host and a sexual phase in another host. Asexual reproduction of some ciliates and flagellates is associated with cyst formation, and sexual reproduction of Sporozoa invariably results in a cyst. Pathogenic protozoa can spread from one infected person to another by: • Faecal – oral transmission of contaminated foods and water. Factors that are important for pathogenecity include: • Attachment to the host tissue followed by replication to establish colonization. Antiprotozoal agents Generally the antiprotozoal agents target relatively rapidly proliferating, young, growing cells of the parasite. Most commonly, these agents target nucleic acid synthesis, protein synthesis, or specific metabolic pathways. Entamoeba histolytica Morphological features (a) Trophozoites Viable trophozoites vary in size from about 10-60fim in diameter. The nucleus is characterized by evenly arranged chromatin on the nuclear membrane and the presence of a small, compact, centrally located karyosome. The cytoplasm is usually described as finely granular with few ingested bacteria or debris in vacuoles. As the cyst matures, the glycogen completely disappears; the chromotiodials may also be absent in the mature cyst.

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When it comes to purchase 500mg valproate mastercard the Chinese medical treatment of such knotty valproate 500mg with mastercard, multipattern conditions cheap 500mg valproate, there are certain Chinese Stastical outcomes studies and representative case histories medical theories and principles which can help one under for most of the diseases covered in this text are available from stand and untie such complicated webs effective 500 mg valproate. Blue Poppy Press currently publishes over Wan-su’s theory of similar transformation, Li Dong-yuan’s 275 Research Reports on almost as many Western diseases, theory of yin fire, and Zhu Dan-xi’s theory of the six depres with new Research Reports being added on a regular basis. Thus, unlike most such treatment manuals, the first Each Blue Poppy Research Report contains abstracts of one part of this book is devoted to an explanation of these or more clinical audits or other outcomes studies published extremely useful theories. Many of these reports also contain representative case histories as per the second part of this book is the treatment formulary sec Chinese medical convention. Like most textbooks of this genre, each disease or con publishes a quarterly on-line Chinese medical journal. Subscriptions of presentation is a convention meant to demonstrate the to this journal are free, and the journal can be accessed at: main disease mechanisms at work in each disease in as “high However, the reader is advised to always keep in mind that this method of presentation is only a con We hope this book will be useful to many Western practi vention. The authors take full responsi cated, multipart patterns under each condition as possible, bility for any errors contained herein and ask our readers to the patterns that appear in Chinese medical textbooks such send us their corrections, amendments, and advice. We as this are only building blocks which must be combined and would also like to thank Drs. In Chinese medicine, patients are not squeezed into Simon Becker for their review of our working manuscript patterns to make them fit. Rather, patterns are modified and their many pieces of valuable advice which were includ around the patient to completely reflect each patient as they ed in our finished product. However, because of the constraints of language and Western diseases with traditional Chinese medicine. Therefore, at some point, the reader must fall back recipes from a cookbook is mistaken. After practicing on their own understanding of and proficiency in Chinese Chinese medicine, in Bob Flaws’s case, for more than 20 medicine’s prescriptive methodology. Hence, unlike most years and having written, translated, and edited scores of other clinical manuals of Chinese medicine, we feel that it is similar clinical manuals in both English and French, we can important to take some time to clarify this methodology in tell you this is just not possible. At least it is not possible if order to help the reader understand what books such as this your goal is to practice Chinese medicine skillfully at the can and cannot do. Books such as this are meant to and can only act as starting places for thinking about and applying 1. Every patient is unique, and, therefore, in profes First of all, before being able to use the information in this sional Chinese medicine, every patient requires their own book, we must presuppose that our readers have successfully individualized treatment plan. It is such individually tailored completed certain basic courses in their Chinese medical treatment plans which make Chinese medicine the safe, training. In terms of acupuncture, those prerequisite courses effective, and holistic medicine it is. In terms of Chinese herbal medicine, the necessary preliminary courses are shown in the It is the prescriptive and problem-solving methodology of table on top of the next page. Professional Chinese medicine is a way of thinking, not a bag In China today, entry-level students study either acupuncture of clinical tricks from the mysterious East. Each is its own five year, 4,000 such as this suggest this or that formula or this or that group hour, full-time course of study. This con tion, they are implicitly juxtaposing this methodology with temporary separation in the practice of these two modalities that of basing treatment primarily on the patient’s disease mirrors the situation in most Asian countries throughout the diagnosis. Basing treatment primarily on disease diagnosis expected to learn both modalities in 3-4 years of often part is the prescriptive methodology of both modern Western time training possibly conducted at night and on weekends. According to this Because most Western practitioners of Chinese medicine latter methodology, patients with the same disease get the practice both modalities concurrently on the majority of their same treatment. However, in standard professionally prac patients, we have given both Chinese medicinal and acupunc ticed Chinese medicine, patients with the same disease do ture protocols for each pattern of each disease discussed. Thus it is said: However, to practice either modality competently requires a great deal of study and practice. Further, some diseases Different diseases, same treatment (yi bing tong zhi) respond better to internal medicine than to acupuncture, Same disease, different treatment (tong bing yi zhi) while other diseases are adequately treated by acupuncture alone. When one is truly competent in either of these modal this means that two patients with different named disease ities, then one understands what one can and cannot treat diagnoses will receive different Chinese medical treatments if efficiently and effectively. In fact, not only will the the scope of one’s personally practiced modality should be treatment for one patient not help the other, it may, in fact, referred to a specialist expert in the other modality. Conversely, two patients with different disease diagnoses will receive the same treatment in Chinese If one has not completed the above elementary courses in medicine if their Chinese patterns are the same. For instance, Chinese medicine, then one cannot reasonably and respon one patient may be diagnosed as suffering from systemic sibly use the material in this or similar Chinese medical lupus erythmatosus and another from Lyme disease. Chinese medicine is not safe and effective Western medicine, these are two different disease diagnoses. One is an autoimmune disease and the other is an infectious Chinese medicine is safe and effective because of its pre disease. Nevertheless, if these two patients both exhibit the scriptive methodology, and one cannot apply this prescrip same Chinese patterns, their Chinese medical treatment will tive methodology in a professionally standard, competent be essentially the same and possibly even identical. However, the defining signs Basically, the Chinese medical prescriptive methodology can and symptoms of patterns are always more inclusive than the be summed up in four Chinese words: bian zheng lun zhi. Said the other way this means that, no matter what the patient’s disease diag round, the defining signs and symptoms of a disease are nosis, professionally administered Chinese medical treat always only part of the signs and symptoms of the patient’s ment is primarily predicated on the patient’s Chinese pattern pattern. Thus the relationship between dis ment’s not completely fitting the totality of a patient’s con eases and patterns is that between figure and ground or tree dition, at least as defined by Chinese pattern discrimination. The signs and symptoms defining a patient’s dis Within Chinese medicine, because the body is seen as a sin ease are like a figure existing against the backdrop of its gle, integrated, organic whole, eliminating one symptom ground or like a tree or clump of trees standing in a forest. Except in very limited circumstances, such as Take for instance the Western disease diagnosis of migraine Herxheimer reactions discussed below, this kind of short headache.

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